Yttrium-90 radioembolization as a palliative treatment for liver tumors: a case study.

The best chance of cure for patients with liver cancer is surgical removal, but many tumors are too large or invasive. In addition, chemotherapy is frequently unsuccessful in this patient population. A case study is featured involving a patient determined to be a candidate for Yttrium-90 radioembolization, a minimally invasive liver-directed treatment used to target primary and metastatic liver tumors by delivering radioactive microspheres directly to the tumor. This article provides an introduction to the procedure, as well as practical information for nurses caring for patients with liver cancer following Yttrium-90 radioembolization.AT A GLANCE: Yttrium-90 radioembolization allows larger radiation doses to be used without affecting healthy tissues.An outpatient procedure, Yttrium-90 radioembolization results in fewer side effects than standard treatment.
Although Yttrium-90 radioembolization can extend and improve quality of life, its intent is palliative, not curative.

Management for the case of twice ruptured anterior communicating artery aneurysm: from nursing perspective.

The anterior communicating artery (ACoA) is the most common site of cerebral aneurysms, accounting for as much as 36% of aneurysms. Microsurgical clipping and coil embolization are treatment modalities for ruptured and nonruptured cerebral aneurysms. Compared with surgical clipping, coil embolization has a relatively lower mortality and incidence of cognitive impairment in patients. However, successful management of the patient with twice ruptured ACoA aneurysm is facing critical challenges.This article has described a case of twice ruptured aneurysm with the first rupture occurring when the patient was admitted and the second rupture occurring during coil embolization. Perioperative nursing assessment, monitoring, intervention, patient teaching, and the nurse's role are discussed from a nursing perspective.

Tratamento endovascular da disfunção erétil por fístula arterioesponjosa traumática: relato de caso / Endovascular treatment of erectile dysfunction by arteriospongiosum traumatic fistula: case report

A disfunção erétil (DE) representa um distúrbio comum de caráter multifatorial. Os autores relatam um caso de paciente vítima de trauma perineal evoluindo com DE por fístula da artéria bulbar para o corpo esponjoso peniano, promovendo um shunt arteriovenoso culminando com déficit de ereção, congestão peniana e dor. O mesmo foi submetido ao tratamento endovascular por embolização com sucesso e encontra-se no sexto mês de acompanhamento ambulatorial, com retorno às suas atividades sexuais e sem queixas de rigidez peniana e dor.

The erectile dysfunction (ED) is a common multifactorial disorder . The authors report a case of perineal trauma patients with evolving secondary bulbar penile artery fistula to the spongy body, promoting an arteriovenous shunt culminating with a deficit of erection, congestion and penile pain. The same was treated by endovascular embolization with success and is in 6¢ªmonths of follow up with return to sexual activity and no complaints of penile rigidity and pain.

Functional capacity of patients in the early period after the embolization of cerebrovascular malformations: preliminary findings.

Research into outcomes of endovascular intervention for cerebral blood vessel malformations has previously focused on the clinical picture of the disease, death rate, comparison of surgical methods, and the most common postoperative and postbleeding complications. From the nursing standpoint, the crucial elements in assessing postoperative patients are functional outcome defining patients' ability to function in life and recognition of impairments in which patients will be dependent on the nursing staff. The aim of the study was to assess functional capacity of patients before and after the embolization of cerebral blood vessel malformations in the aspect of nursing care. The study included 38 patients after embolization of cerebral blood vessels. The assessment of their condition using the Functional Capacity Scale was performed twice: before and after the surgical procedure. The research shows that on the day of admission to hospital, patients had greatest difficulty performing hygienic activities (p < .0001), satisfying physiological needs (p < .0001), and consuming their meals (p < .004). Headache (p < .002) and poor psychological state (p < .0001) manifesting itself through mild depression constituted other serious problems. After the surgery, vast majority of patients were independent in terms of self-care (p ≤ .03). Headache occurred in the case of 21% of patients, and psychological state improved in 34% of patients, which shows that there is a major demand for care in this sphere.

Embolização da reperfusão do aneurisma da artéria poplítea com Onyx / Treatment of recurrent popliteal artery aneurysm with Onyx embolization

O aneurisma da artéria poplítea é o mais frequente dos aneurismas periféricos verdadeiros. Embora seja assintomático, apresenta complicações isquêmicas por embolia ou trombose. A correção deste aneurisma pode ser cirúrgica convencional, com técnica e prognóstico bem estabelecidos, ou endovascular, técnica inovadora e menos invasiva. A reperfusão do saco aneurismático excluído, apesar de rara, está relacionada à intensa circulação colateral. Relatamos um caso de aneurisma de poplítea, que após dois anos de exclusão apresentou fluxo no saco aneurismático com sintomatologia, sendo tratado por técnica endovacular alternativa.

The popliteal artery aneurysm is the most frequent of the peripheral aneurysms. Although asymptomatic, it can complicate with severe limb ischemia due to embolization or thrombosis. The surgical correction presents well-established techniques and results, while the less invasive endovascular therapy is still evolving. The recurrence is very rare and can be related to collateral artery refilling. We report a recurrent popliteal artery aneurysm after two years of conventional ligation and bypass surgery, in which an alternative endovascular strategy was successfully applied.

Tratamento endovascular de pseudoaneurisma da aorta abdominal: relato de caso / Endovascular treatment of an abdominal aortic pseudoaneurysm: a case report

Um estudante de 17 anos, masculino, sofreu ferimentos por arma de fogo e foi submetido a uma laparotomia exploradora. No pós-operatório, queixava-se de dores em membros inferiores e de massa abdominal pulsátil. Realizou tomografia computadorizada (TC) de abdome, que evidenciou pseudoaneurisma de aorta abdominal de cerca de 8 cm no maior diâmetro, localizado entre o tronco celíaco e a artéria mesentérica superior. Uma arteriografia confirmou o diagnóstico e procedeu-se, então, a embolização da lesão com fragmentos de fio-guia montados com fios de algodão. Após seis meses, realizou ecoDoppler de aorta abdominal e nova TC de abdome, que evidenciaram fluxo no interior do saco do pseudoaneurisma. Foi, então, submetido a nova embolização endovascular e implante de stent não-revestido de 18 x 58 mm. Após seis meses do último procedimento, realizou-se nova TC de abdome que demonstrou exclusão da lesão.

A 17 years old male student has received several gunshots and was submitted to exploratory laparotomy. After surgery, he complained of pain in the lower limbs and a pulsatile abdominal mass. An abdominal computerized tomography (CT) scan was carried out and revealed an abdominal aorta pseudoaneurysm of about 8 cm in the larger diameter between the celiac trunk and the superior mesenteric artery. An arteriography confirmed the diagnosis and he was submitted to the lesion embolization with cotton suture wires attached to metallic guide wire fragments. After six months, an abdominal aorta Doppler ultrasonography and a new abdominal CT scan were ordered and depicted flow inside the pseudoaneurysm. The patient was then submitted to a new endovascular embolization, and an 18 x 58 mm uncovered stent was placed. After six months from the last procedure, a new abdominal CT scan showed exclusion of the lesion.

Embolization of pulmonary arteriovenous malformations with amplatzer vascular plugs: safety and midterm effectiveness.

PURPOSE: To evaluate the safety and effectiveness of Amplatzer vascular plugs (AVPs) for percutaneous closure of arteries feeding pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS: Over a 45-month period, 24 consecutive patients with at least one PAVM treated with an AVP were selected from a database on patients with a PAVM who received embolotherapy. Immediate technical success was defined as the complete absence of flow through the PAVM after embolization without the need for additional embolization material. Success on follow-up imaging was defined as a reduction in size of at least 70% of the aneurysm or draining vein on follow-up computed tomography or the absence of flow through the PAVM on a subsequent pulmonary angiogram. RESULTS: Thirty-seven AVPs were used to close 36 feeding arteries in 35 PAVMs in seven male and 17 female patients aged 11-86 years (mean age, 50 y). Technical success was achieved in 35 feeding arteries (97%). One feeding artery required two AVPs for closure. There were no immediate procedure-related complications. At a mean clinical follow-up of 322 days (range, 1-1,126 d), all patients were alive without new PAVM-related complications. Imaging follow-up was available for 29 embolized vessels (81%) with a mean follow-up of 418 days (range, 40-937 d), and recanalization occurred in two treated vessels (7%). CONCLUSIONS: AVPs are safe and effective for closure of PAVMs feeding vessels that can be reached with a guiding catheter, with an acceptable rate of recanalization.

Cuidados de enfermería al paciente sometido a técnicas de neurointervencionismo endovascular / Nursing care in patients undergoing interventional neuroendovascular procedures

Las exploraciones de radiología vascular intervencionista (RVI) han aumentado de manera notoria. Ha contribuido a ello el contexto sanitario actual, con necesidad de potenciar procedimientos menos invasivos que reduzcan la presión en las áreas quirúrgicas y las estancias hospitalarias. Estas técnicas permiten, en la mayoría de los casos, realizar en una única intervención diagnóstico y tratamiento. Se basan en la posibilidad de acceder a estructuras vasculares del organismo mediante un catéter que se introduce de forma percutánea sin necesidad de cirugía abierta. Debido a la complejidad de estos procedimientos se requiere ingreso previo a la técnica y estancia posterior, aunque de corta duración, que contrasta con las de cirugía. La enfermera, como referente más próximo del paciente, debe responder a las necesidades de información. La prestación de unos cuidados de enfermería integrales debe contemplar los cuidados previos, durante y después del procedimiento y todos los aspectos relacionados con la calidad del proceso asistencial. Para ello es básico conocer cómo se desarrollan las técnicas de RVI diagnósticas y terapéuticas en el área neurovascular. A partir de la experiencia de los autores, el presente artículo tiene como objetivo que las enfermeras conozcan algunos de los procedimientos neurointervencionistas (angiografía cerebral y embolización de aneurismas intracraneales) y los cuidados que se prestan en las salas de RVI(AU)

Vascular interventional radiology (VIR) procedures have increased markedly, partly due to the current healthcare context, which encourages the use of less invasive procedures that reduce pressure on surgery departments and decrease hospital stays. In most patients, these techniques can be carried out in a single intervention. VIR procedures are based on the possibility of gaining access to vascular structures through a catheter inserted percutaneously without the need for open surgery. Due to the complexity of these procedures, hospitalization is required before and after the technique is performed but length of stay is short compared with that associated with surgery. As the health workers closest to patients, nurses must respond to their information needs. The provision of comprehensive nursing care should include all the care required before, during and after the procedure and all aspects related to the quality of the healthcare process. Knowledge of how diagnostic and therapeutic VIR techniques are performed in the neurovascular section is essential. Based on the authors’ experience, the present article aims to provide nurses with knowledge of some neurointerventional procedures (cerebral angiography and embolization of intracranial aneurysms) and of the care provided in RVI rooms(AU)

[Nursing care in patients undergoing interventional neuroendovascular procedures]. / Cuidados de enfermería al paciente sometido a técnicas de neurointervencionismo endovascular.

Vascular interventional radiology (VIR) procedures have increased markedly, partly due to the current healthcare context, which encourages the use of less invasive procedures that reduce pressure on surgery departments and decrease hospital stays. In most patients, these techniques can be carried out in a single intervention. VIR procedures are based on the possibility of gaining access to vascular structures through a catheter inserted percutaneously without the need for open surgery. Due to the complexity of these procedures, hospitalization is required before and after the technique is performed but length of stay is short compared with that associated with surgery. As the health workers closest to patients, nurses must respond to their information needs. The provision of comprehensive nursing care should include all the care required before, during and after the procedure and all aspects related to the quality of the healthcare process. Knowledge of how diagnostic and therapeutic VIR techniques are performed in the neurovascular section is essential. Based on the authors' experience, the present article aims to provide nurses with knowledge of some neurointerventional procedures (cerebral angiography and embolization of intracranial aneurysms) and of the care provided in RVI rooms.

Brain Tumour Foundation Award 2007. Glomus jugulare tumours: are they really so benign?

Glomus jugulare tumours are rare, hypervascular and usually benign tumours involving the skull base. Diagnosis can be significantly delayed due to the slow and insidious clinical presentation. The primary manifestations involve auditory and lower cranial nerve deficits. Treatment options may include surgery, radiation and embolization. Surgery is the optimal treatment modality, but is not without serious potential complications. These complications are linked to the location and vascular nature of the tumour. Glomus jugulare tumours present a significant diagnostic and management challenge to all members of the health care team.

Endovascular coiling for cerebral aneurysms.

Aneurysmal subarachnoid hemorrhage is an increasing problem in the United States, affecting approximately 30,000 people every year. Despite advances in the neurosurgical field, approximately 50% of patients die within the first month after hemorrhage. Traditionally, craniotomy with aneurysmal clipping has been employed to manage these patients, but endovascular embolization is moving to the forefront of treatment, particularly for high grade (IV to V) aneurysms. Patient selection is often based on age, aneurysm size, location, characteristics and presentation, and patient hemodynamics. Postprocedure management relies on skilled observers to determine those potential complications that may occur, including vasospasm, rupture, bleeding, or vessel occlusion. Advanced practice nurses have an obligation to be aware not only of the procedure and its management, but also of the potential complications and ongoing care of the patients and families as well.

Carotid-cavernous sinus fistula: a case study.

Carotid-cavernous sinus fistulae are rare, but serious, vascular anomalies which may develop following traumatic injury to the skull base. Fractures or the shearing forces of severe head trauma may cause the internal carotid artery to be torn from its points of dural attachment and rupture, with resultant direct flow into the cavernous sinus. Current treatment options for carotid-cavernous sinus fistulae are surgery and coil embolization, with embolization being the most common. Clinicians and nurses treating patients with these injuries should have an understanding of this vascular entity, because prompt intervention helps to prevent permanent disability and improve patient outcomes. This case study reports the diagnosis and treatment of a carotid-cavernous sinus fistula that developed several months after a traumatic head injury.

Trends and treatment of cerebral aneurysms: review and case studies.

Subarachnoid hemorrhage (SAH) often results in devastating neurological deficits requiring hospitalization and loss of independence. This is often a difficult time for patients and their families who are struggling to cope with this sudden illness. Current treatment options include surgical clipping of the aneurysm or endovascular obliteration using Guglielmi Detachable Coils. Our purpose in writing this paper will be to review the factors that determine the choice of treatment, and to discuss how nurses can provide our patients and families with the support and teaching needed during this difficult time.

An alternative to hysterectomy.

For many women with symptomatic fibroids, hysterectomy has been an undesirable, but definitive, treatment for their condition. The good news is that uterine artery embolization, a new approach that shrinks fibroids by embolizing their blood supply, is proving to be a safe and effective alternative.